Non-sugar sweeteners: helpful or harmful? The challenge of developing intake recommendations with the available research

Abstract:

Key messages

• Non-sugar sweeteners are widely found in the global food supply and are commonly used to replace added sugars in the diet

• Recommendations surrounding non-sugar sweetener consumption are inconclusive and conflicting, with scarce evidence on long term effects

• Several factors contribute to uncertainty about the health effects of non-sugar sweetener consumption, particularly differences in study design, methods, and interpretation of findings

• Additional research is needed to inform conclusive recommendations for or against the use of non-sugar sweeteners

• Guidelines for non-sugar sweetener use should consider individual types of sweeteners and specific population subgroups such as children, pregnant and breastfeeding women, and people with diabetes

Non-sugar sweeteners are commonly used as replacements for added sugars, both in the general population and among people with obesity and diabetes. Because of ongoing efforts to lower added sugar intake, non-sugar sweeteners have become ubiquitous in the global food supply. The global market for non-sugar sweeteners is expected to grow, with a predicted market value of more than $408bn in 2032—a growth of 7.2% in 10 years.1 

Although their use is widespread and increasing, there is uncertainty about their health effects, which has led to inconclusive recommendations for or against their consumption.

The challenge of developing conclusive intake recommendations for non-sugar sweeteners is particularly timely: in May 2023, the World Health Organization released a guideline for people without diabetes that recommended against using non-sugar sweeteners for weight control and prevention of non-communicable diseases.2 

Notably, the WHO guideline did not provide recommendations for people with diabetes, who make up around 10% of the world’s population and commonly use non-sugar sweeteners as a tool for maintaining glycaemic control.3 Because of the limitations of the available research, however, the WHO guideline is considered conditional and is based on evidence of low certainty.

The limitations of the research are not specific to the WHO guideline and pervade existing recommendations. This underscores the need for additional research to inform more conclusive guidance tackling the health effects of individual types of non-sugar sweeteners, and to focus on examining their effects in specific population subgroups.